Muzaffer Temur

Epidermal cyst in an unusual site: A case report

Highlights • Epidermal cysts can be located in any part of the body, though mainly on the face, torso, extremities and scalp, but they are rarely localized on the vulva.• Most of the vulvar epidermal cysts described so far have been localized on the clitoris; and circumcision procedures and trauma have been demonstrated as underlying causes.• Our patient, had not been previously exposed to trauma or undergone any surgical intervention.• Vulvar epidermal cyst should be considered in the differential diagnosis of vulvar mass.

Comparative evaluation of the risk of malignancy index scoring systems (1-4) used in differential diagnosis of adnexal masses.

BACKGROUND To determine the cut-off values of the preoperative risk of malignancy index (RMI) used in differentiating benign or malignant adnexal masses and to determine their significance in differential diagnosis by comparison of different systems. MATERIALS AND METHODS 191 operated women were assessed retrospectively. RMI of 1, 2, 3 and 4; cut-off values for an effective benign or malignant differentiation together with sensitivity, specificity, negative and positive predictive values were calculated. RESULTS Cut-off value for RMI 1 was found to be 250; there was significant (p<0.001) compatibility at this level with sensitivity of 60%, positive predictive value (PPV) of 75%, specificity of 93%, negative predictive value (NPV) of 88% and an overall compliance rate of 85%. When RMI 2 and 3 was obtained with a cut-off value of 200, there was significant (p<0.001) compatibility at this level for RMI 2 with sensitivity of 67%, PPV of 67%, specificity of 89%, NPV of 89%, histopathologic correlation of 84% while RMI 3 had significant (p<0.001) compatibility at the same level with sensitivity of 63%, PPV of 69%, specificity of 91%, NPV of 88% and a histopathologic correlation of 84%. Significant (p<0.001) compatibility for RMI 4 with a sensitivity of 67%, PPV of 73%, specificity of 92%, NPV of 89% and a histopathologic correlation of 86% was obtained at the cut-off level 400. CONCLUSIONS RMI have a significant predictability in differentiating benign and malignant adnexal masses, thus can effectively be used in clinical practice.

Placental bed apoptosis is increased in pregnant women with pre-eclampsia versus normotensive pregnant women

abstract We hypothesised that apoptosis in the placenta is increased in pregnant women whose pregnancies were complicated by pre-eclampsia as compared to normal pregnant women. Biopsy samples were obtained by punch biopsy from placental beds in 15 pre-eclamptic and 15 normotensive pregnant women during cesarean section. Apoptosis in syncytiotrophoblasts, syncytial cluster, extravillous cytotrophoblast, and decidual and stromal cells were evaluated by caspase-3, bax and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labelling (TUNEL) immunohistochemical methods. A significant involvement was observed via caspase-3 and TUNEL methods in the syncytiotrophoblasts, syncytial cluster and extravillous cytotrophoblast cells of the pre-eclamptic group versus normotensive group (p < 0.001). Caspase-3 method found significantly increased involvement in the pre-eclamptic group versus normotensive group (p < 0.001). Although bax method found significantly increased involvement in syncytiotrophoblasts in the pre-eclamptic group versus normotensive group (p < 0.001), no significant difference was found between the groups in terms of involvement of other cell groups (p > 0.05). Apoptosis in the placental bed is increased in pre-eclamptic woman.

Increased circulating urocortin-3 levels is associated with polycystic ovary syndrome

Abstract This study was aimed to compare serum urocortin-3 (UCN3) levels in women with polycystic ovary syndrome (PCOS) and healthy women, and establish what role UCN3 levels play in PCOS. Fifty-two patients with PCOS and 55 healthy women were included in the study, matched for age and body mass index. Fasting blood glucose (FBG), insulin, hs-CRP, UCN3 and free-testosterone levels of the all participants were measured. HOMA-IR was used to calculate the insulin resistance. Circulating UCN3 levels were significantly increased in women with PCOS than in control subjects (54.49 ± 5.77 versus 51.28 ± 5.86 pmol/l, p = 0.005). Serum insulin, hs-CRP and HOMA-IR levels were higher in women with PCOS than in control group. UCN3 levels positively correlated with hs-CRP in PCOS group (r = 0.391, p = 0.004). Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curves were 0.732 (95% CI 0.634–0.830, p < 0.001) for UCN3 levels. The optimal cut-off value of UCN3 for detecting PCOS was ≥51.46 pmol/l, at which the sensitivity was 75% and specificity was 68%. Our results suggest that there is a potential link between PCOS and UCN3 levels. The results of this study support the presence of increased UCN3 levels for the association of inflammation with PCOS.

Polycystic ovary syndrome is associated with increased osteopontin levels.

OBJECTIVE Osteopontin (OPN) is a multi-functional secreted glycoprotein that plays a crucial role in glucose metabolism and inflammatory process. Growing evidence suggests that there is a link between OPN and ovarian function. However, no such link has yet been found for OPN in polycystic ovary syndrome (PCOS). Our aim was to ascertain whether circulating OPN levels are altered in women with PCOS and to determine whether OPN levels differ between the follicular phase and mid-cycle of the menstrual cycle in eumenorrheic women. DESIGN AND METHODS In total, 150 women with PCOS and 150 age- and BMI-matched controls without PCOS were recruited for this prospective observational study. OPN levels were measured using ELISA. Metabolic parameters were also determined. RESULTS Circulating OPN levels were significantly elevated in PCOS women compared with controls (69.12±31.59  ng/ml vs 42.66±21.28  ng/ml; P<0.001). OPN levels were significantly higher at mid-cycle than in the follicular phase in eumenorrheic women. OPN was positively correlated with BMI, homeostasis model assessment of insulin resistance (HOMA-IR), free testosterone, and high sensitivity C-reactive protein (hs-CRP). Multivariate logistic regression analyses revealed that the odds ratio (OR) for PCOS was 3.64 for patients in the highest quartile of OPN compared with those in the lowest quartile (OR=3.64; 95% CI=2.42-5.57; P=0.011). Our findings indicate that BMI, HOMA-IR, hs-CRP, and free testosterone are independent factors influencing serum OPN levels and that OPN is an independent predictor for HOMA-IR. CONCLUSION PCOS is associated with increased OPN levels.

Association between red blood cell distribution width and polycystic ovary syndrome.

Abstract Aims: The red blood cell distribution width (RDW) is being recognized as a marker of chronic inflammation and routinely reported as part of a complete blood count (CBC) without any additional costs. High levels of RDW associate with oxidative stress and cardiovascular disease risk. We aimed to investigate the relation between the level of RDW and high-sensitive C-reactive protein (hs-CRP), HOMA-IR, BMI and body fat percentage in women with polycystic ovary syndrome (PCOS). Materials and methods: Cross-sectional and observational studies were conducted in 90 subjects with PCOS and 87 age- and BMI-matched controls. Body fat percentage, CBC, fasting serum glucose, serum insulin, hs-CRP, lipids, and total and free-testosterone levels were measured. Results: RDW levels were significantly higher in the PCOS group compared with the control group (12.98 ± 0.92% versus 12.59 ± 0.84%, p = 0.004). RDW levels were positively correlated with hs-CRP, HOMA-IR and BMI. Multivariate analysis showed that high-RDW levels were associated with PCOS. Subjects with the highest quartile RDW levels were nearly 2.8 times more likely to develop PCOS compared with subjects with the lowest quartile RDW. ROC curve analysis showed that RDW levels were useful as a diagnostic marker for PCOS. The optimal cut-off value for detecting PCOS was ≥12.54% (sensitivity 67% and specificity 70%). Conclusions: RDW levels were higher in women with PCOS, and high-RDW levels were independently associated with PCOS. This link in between RDW and PCOS may be due to an underlying chronic inflammation in subjects with PCOS.

The effect of prolactin levels on MPV in women with PCOS

Polycystic ovary syndrome (PCOS) is associated with cardiovascular risk factors including hypertension, obesity, hyperlipidaemia and glucose intolerance. Several studies demonstrated the link between PCOS and an increased risk of cardiovascular disease. Platelets play a crucial role in the development of atherothrombotic disease. Mean platelet volume (MPV) is a marker of platelet size that reflects its activity. Research points to a link between prolactin (PRL) and platelet activation. The purpose of this study was to investigate whether prolactin levels are associated with MPV in women with PCOS.

Nuchal translucency measurement: who is right, who is not?

Objective: Fetal nuchal translucency (NT) measurement at first trimester provides prediction for fetal aneuploidy and cardiac anomalies. Performance of NT as a screening marker has not been consistent in studies. Measurement of NT has high intraand interobserver variability. Radiologists, obstetricians and perinatology experts measure the NT. There is no consensus about who should perform the NT measurement. In this study we compared the correlation of NT measurement in three groups depend on mean thickness and distribution of NT. Methods: A total of 929 participants were recruited for this study. 7 radiologists, 8 obstetricians and 1 perinatology expert measured NT. Crown-rump length (CRL), mean NT and NT distribution were calculated for each group. Results: Perinatology expert’s mean NT measurement was significantly higher than that of radiologists and obstetricians (p<0.05). Measurements of the perinatal expert also had significantly different distribution than other groups (p<0.05). There was no significant difference between the groups in terms of CRL values. Interobserver reliability coefficients with 95% confidence intervals for CRL and NT were 0.967 (0.910–0.987, p<0.001) and 0.596 (0.455–0.845, p<0.001), respectively. Conclusion: There are statistically significant differences for mean NT value and distribution in three groups. Measurements of the perinatal expert has higher mean thickness and distribution. It is obvious that there is a need for standardization in NT measurement and it is necessary to evaluate the perinatal outcomes of these three groups and to approximate the two groups with the most accurate result group.

Relationship between endometrial thickness and neutrophil/lymphocyte ratio with endometrial malignancy in 386 postmenopausal uterine bleeding cases

Introduction: In our study, endometrial thickness with neutrophil/lymphocyte ratio and endometrial sampling results were compared in terms of outcome in women with postmenopausal bleeding. In addition, we aimed to determine the predictive value of endometrial thickness and neutrophil/lymphocyte ratio for predicting endometrial carcinoma. Material and methods: Our single-centered study was performed retrospectively. The study included 386 postmenopausal women admitted to our gynecology outpatient clinic for abnormal uterine bleeding between January 2015 and June 2017 and subjected to endometrial sampling. Results: The mean endometrial thickness for endometrial hyperplasia was calculated as 13 mm (min. 4 mm, max. 20 mm) and for endometrial carcinoma 17.19 mm (min. 8 mm, max. 27 mm). The neutrophil count and neutrophil/lymphocyte ratio (NLR) were significantly higher and the lymphocyte count was lower in the group with endometrial malignancy (p = 0.002, p < 0.001 and p = 0.011, respectively). None of the patients with endometrial thickness < 8 mm received an endometrial carcinoma diagnosis. The optimal cut-off value of endometrial thickness for detecting endometrial carcinoma was ≥ 13.50 mm, at which the sensitivity was 75% and specificity was 83.6%. The optimal cut-off value of NLR for detecting endometrial carcinoma was ≥ 2.20, at which the sensitivity was 81.3% and specificity was 60.5%. Conclusions: Co-evaluation of NLR with endometrial thickness determined by transvaginal sonography might be useful for predicting endometrial carcinoma.

A national measure to reduce primary cesarean rates in Turkey

Abstract Purpose: To examine the influence of the “Physician Unit Performance Coefficient” (PUPC) regulation, taken into force by the TR Ministry of Health in January 2013 in our country, based on the cesarean rates in our clinic. Methods: The pregnant women who gave birth at the Diyarbakır Maternity and Pediatrics Hospital within a period of three years before the PUPC has been taken into force and the pregnant women who have birth within a period of three years after January 2013, when the regulation has been taken into force, have been divided into two groups as Group 1 and Group 2, respectively. Comparisons have been made between the two groups with respect to primary cesarean, total cesarean, neonatal mortality, and maternal mortality rates. Results: From the 125,816 pregnant women who gave birth between February 2010 and January 2016, 58,856 (46.7%) are included in Group 1 and the remaining 66,960 (53.3%) are in Group 2. The total Cesarean Rate is 27% in Group 2 and 24.8% in Group 1. The primary Cesarean Rate is 11.3% in Group 2 and 13.5% in Group 1. The neonatal mortality rate is 7.81‰ in Group 2 and 10‰ in Group 1. The differences in the total cesarean rates, primary cesarean rates and neonatal mortality rates have been found statistically significant. Maternal mortality rates have been found to be 5.1 in 100,000 in Group one and 4.48 in 100,000 in Group 2 and the difference between the two groups has not been found as statistically significant. Conclusions: A meaningful reduction has been achieved in the primary cesarean rates without increasing maternal and neonatal mortality rates after the PUPC, implemented by the TR Ministry of Health, has been taken into force.